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Danish Analysis Indicates Increased Risk of Late Adverse Outcomes in Patients Treated for Relapsed Disseminated Testicular Germ Cell Cancer

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Key Points

  • Patients surviving after more than one line of treatment had an increased risk of second cancer, major cardiovascular disease, pulmonary disease, gastrointestinal disease, renal impairment, and neurologic disorders.
  • These patients were also at increased risk of death due to causes other than germ cell cancer.

In a Danish analysis reported in the Journal of Clinical Oncology, Lauritsen et al found that patients with testicular germ cell cancer who survived after more than one line of treatment for disseminated disease had an increased risk of late toxicity and death resulting from causes other than germ cell cancer.

Study Details

The study involved data from 268 patients in the Danish Testicular Cancer data base who received more than one line of treatment for disseminated germ cell cancer. Data on late toxicity and mortality were obtained by linkage to national registers. Prognostic factors for relapse and death were identified and compared with the International Prognostic Factors Study Group (IPFSG) classification.

Increased Risks

Overall, 136 patients (51%) died of germ cell cancer. Compared with patients who received only orchiectomy, the remaining 132 patients had an increased risk of second cancer (hazard ratio [HR] = 3.2, 95% confidence interval [CI] = 1.9–5.5), major cardiovascular disease (HR = 1.9, 95% CI = 1.0–3.3), pulmonary disease (HR = 2.0, 95% CI = 1.0–3.8), gastrointestinal disease (HR = 7.3, 95% CI = 3.6–14.8), renal impairment (HR = 8.3, 95% CI = 3.0–23.2), neurologic disorders (HR = 6.3, 95% CI = 3.1–12.6), and death as a result of other causes (HR = 2.6, 95% CI = 1.6–4.2).

The prognostic value of the IPFSG classification was generally confirmed in the study population, although the primary site and human chorionic gonadotropin level were not confirmed as independent factors. Increasing age was identified as a potential prognostic factor for treatment failure after second-line treatment (HR = 1.2 per 10 years, 95% CI = 1.2–15).

The investigators concluded: “Patients with [germ cell cancer] who survive after more than one line of treatment for disseminated disease have a highly increased risk of late toxicity and death as a result of causes other than [germ cell cancer]. Therefore, they should be candidates for life-long follow-up. The IPFSG classification was confirmed in this unselected population.”

Gedske Daugaard, MD, DMSc, of Copenhagen University Hospital, is the corresponding author of the Journal of Clinical Oncology article.

The study was supported by grants from the Danish Cancer Society and Preben and Anna Simonsens Foundation.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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